| NPI | 1376656421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2299514) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VT 101-0030149) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2015-05-28 |