| NPI | 1457660029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 04443) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN264294) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2022-08-24 |