NPI | 1851905426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN02492) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2302181) |
Enumeration Date | 2020-09-01 |
Last Update Date | 2020-12-30 |