| NPI | 1669808473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI CAPRN03635) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9368610) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2023-10-06 |