Graduated: 2010
NPI: 1891088480
Practice Locations (2)
LIFESPAN PHYSICIAN GROUP INC
164 SUMMIT AVE, C70
PROVIDENCE, RI 029062853
4017934545
UNIVERSITY SURGICAL ASSOCIATES, INC.
195 COLLYER ST, SUITE 302
PROVIDENCE, RI 029041869
4017935140
Source: CMS National Downloadable File, September 2026.