| NPI | 1710286331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI NPP37648) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 2261011) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2013-10-31 |