| NPI | 1942551387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI NPP32681) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT R51200) |
| 163W00000X Registered Nurse (Licence: MA RN223336) | |
| 163W00000X Registered Nurse (Licence: RI RN32681) | |
| 363L00000X Nurse Practitioner (Licence: MA RN22336) | |
| 363L00000X Nurse Practitioner (Licence: CT 005004) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |