| NPI | 1568862738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: RI APRN00970) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN00970) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2024-02-29 |