| NPI | 1154678472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2268584) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2268584) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2268584) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2020-10-28 |