| NPI | 1659052736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN03515) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN04537) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2025-12-22 |