| NPI | 1073243804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2371965) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN F04220432) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2023-01-11 |