| NPI | 1366024523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2371065) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95015353) |
| 163W00000X Registered Nurse (Licence: MA RN2371065) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2026-05-12 |