| NPI | 1396146742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2273234) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2273234) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2018-02-23 |