| NPI | 1932808326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN04028) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN64611) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2024-04-23 |