| NPI | 1083035885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2272854) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201394073NP-PP) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2018-10-22 |