| NPI | 1487262374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MA RN2288385) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2288385) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2021-11-01 |