| NPI | 1225558133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2323183) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 10247) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-07-06 |