| NPI | 1700404498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN03084) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI APRN03084) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2023-02-02 |