| NPI | 1215360623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: MA rn250380) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN250380) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2019-12-20 |