| NPI | 1386368306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MA RN10017955) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 250443) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2025-01-16 |