| NPI | 1164032397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2317489) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MA RN2317489) |
| 363L00000X Nurse Practitioner (Licence: RI APRN02411) | |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2022-10-01 |