Graduated: 2021
NPI: 1740943281
Practice Locations (2)
LIFESPAN PHYSICIAN GROUP INC
164 SUMMIT AVE
PROVIDENCE, RI 029062853
4017934102
THE MIRIAM HOSPITAL
208 COLLYER ST, SUITE 100
PROVIDENCE, RI 029041560
4017937191
Source: CMS National Downloadable File, September 2026.