| NPI | 1841738473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: RI APRN01676) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN56414) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: CT 8705) | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2022-09-15 |