| NPI | 1134696800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 077816-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2279231) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2018-12-18 |