| NPI | 1891243861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: RI APRN01505) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN56721) |
| 163W00000X Registered Nurse (Licence: MA 2298927) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 2298927) | |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2022-01-24 |