| NPI | 1750356507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI NPP37715) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: RI NPP37715) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2016-02-12 |