| NPI | 1750081535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN03529) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2330244) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2024-03-18 |