| NPI | 1902546203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI PA1450) |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: RI PA01450) | |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2022-05-09 |