| NPI | 1467928184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2269800) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2269800) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2269800) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2269800) | |
| Enumeration Date | 2018-10-20 |
| Last Update Date | 2020-02-07 |