Graduated: 2020
NPI: 1619580156
Practice Locations (2)
LIFESPAN PHYSICIAN GROUP INC
164 SUMMIT AVE, C70
PROVIDENCE, RI 029062853
4017934545
UNIVERSITY SURGICAL ASSOCIATES, INC.
2 DUDLEY ST
PROVIDENCE, RI 029053248
4012721800
Source: CMS National Downloadable File, September 2026.