| NPI | 1750036471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN04619) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI rn55420) |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2025-07-15 |