| NPI | 1144033564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA APRN10003786) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MA RN2372870) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-04-01 |