| NPI | 1942826466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN02408) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: RI F06200729) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2020-09-23 |