| NPI | 1457653081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI NPP37927) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 635219) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 338900) | |
| 163W00000X Registered Nurse (Licence: RI RN53798) | |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2014-10-07 |