| NPI | 1306839204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 058765-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11029034) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2025-05-05 |