| NPI | 1477099190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: RI aprn01449) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN01449) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2023-10-06 |