| NPI | 1649575846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA rn255969) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI APRN01531) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2024-09-12 |