| NPI | 1457436362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA 281715) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R150873) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 0576632303) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2008-12-29 |