Graduated: 2022
NPI: 1669996450
Practice Locations (2)
LIFESPAN PHYSICIAN GROUP INC
593 EDDY ST
PROVIDENCE, RI 029034923
4014446966
NORTHSTAR ANESTHESIA OF VIRGINIA, LLC
3300 GALLOWS RD
FALLS CHURCH, VA 220423307
7037764001
Source: CMS National Downloadable File, September 2026.