| NPI | 1033357124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MA RN274615) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN274615) |
| 363L00000X Nurse Practitioner (Licence: MA 274615) | |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2021-04-22 |