Graduated: 2019
NPI: 1386284768
Practice Locations (2)
LIFESPAN PHYSICIAN GROUP INC
164 SUMMIT AVE, C70
PROVIDENCE, RI 029062853
4017934545
UNIVERSITY SURGICAL ASSOCIATES, INC.
208 COLLYER ST, SUITE 301A
PROVIDENCE, RI 029041560
4012721800
Source: CMS National Downloadable File, September 2026.