| NPI | 1952899510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN01839) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9408369) |
| 363LF0000X Nurse Practitioner, Family (Licence: RI n.a) | |
| Enumeration Date | 2018-04-28 |
| Last Update Date | 2018-07-20 |