| NPI | 1609643063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN03921) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2321336) |
| 163W00000X Registered Nurse (Licence: MA RN2321336) | |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2024-03-08 |