| NPI | 1083001408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2299476) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MA 2299476) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2020-04-21 |