| NPI | 1366035032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2372310) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000201236) |
| 163WN0800X Registered Nurse, Neuroscience (Licence: TN 0000201236) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2372310) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-14 |
| Last Update Date | 2023-02-02 |