| NPI | 1174898233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MA RN174284) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN174284) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |