| NPI | 1467135293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: RI APRN04112) |
| Additional Taxonomies | 163WP0200X Registered Nurse Pediatrics (Licence: CT 167528) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-08-27 |