| NPI | 1245739341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2358169) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 23783) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2023-02-23 |