| 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 |