| NPI | 1356794127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2313147) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2313147) |
| 163W00000X Registered Nurse (Licence: NY 702005) | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2020-03-19 |