| NPI | 1245655489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367A00000X Advanced Practice Midwife (Licence: NH 082177-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NH 082177-23) |
| 363LF0000X Nurse Practitioner Family (Licence: CT 7495) | |
| 363LF0000X Nurse Practitioner Family (Licence: MA 2290476) | |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2020-03-25 |