| NPI | 1982976775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA 2011012631) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI NPP37676) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2024-03-07 |