| NPI | 1255830535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2316620) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2316620) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2019-01-31 |