| NPI | 1891580023 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN04656) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA AG10240049) |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-07-17 |