| NPI | 1790131894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 280256) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN01349) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2018-03-17 |