| NPI | 1720824881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN04178) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV 875824) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-09-24 |