| NPI | 1447659636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN276827) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MA RN276827) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2024-09-06 |