| NPI | 1093315863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN283478) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MA RN283478) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2022-02-10 |