| NPI | 1043984586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN210429) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 088716-23) |
| Enumeration Date | 2021-08-08 |
| Last Update Date | 2024-04-29 |