| NPI | 1083038244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN280167) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI NPP37722) |
| Enumeration Date | 2014-02-08 |
| Last Update Date | 2014-02-08 |