| NPI | 1710384896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN02389) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN276874) |
| 363LF0000X Nurse Practitioner, Family (Licence: RI ETL01150) | |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2024-03-27 |