| NPI | 1134849326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2361626) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2361626) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-02-19 |