| NPI | 1497049514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN165215) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R107149) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2011-06-06 |