Graduated: 1993
NPI: 1093951790
Practice Locations (2)
LIFESPAN PHYSICIAN GROUP INC
593 EDDY ST
PROVIDENCE, RI 029034923
4014444000
PRIME HEALTHCARE SERVICES LANDMARK LLC
115 CASS AVE
WOONSOCKET, RI 028954705
4017694100
Source: CMS National Downloadable File, September 2026.