| NPI | 1285081570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN229896) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MA RN229896) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2021-01-12 |