Graduated: 2024
NPI: 1164237905
Practice Locations (2)
THE MIRIAM HOSPITAL
208 COLLYER ST, SUITE 100
PROVIDENCE, RI 029041560
4017937191
LIFESPAN PHYSICIAN GROUP INC
41 SANDERSON RD, SUITE 103
SMITHFIELD, RI 029172611
4016061004
Source: CMS National Downloadable File, September 2026.