| NPI | 1710169792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN00898) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: RI PNS00001) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2020-03-25 |