| NPI | 1205590890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2357052) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MA P877912) |
| 163W00000X Registered Nurse (Licence: MA RN2357052) | |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2024-05-13 |