| NPI | 1538452735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN00388) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN48410) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2015-02-24 |