| NPI | 1578935649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: RI APRN00743) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: RI APRN00743) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |