| NPI | 1457987604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2293310) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2293310) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2293310) | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2020-07-01 |