| NPI | 1518675750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2333754) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2333754) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2333754) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2333754) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2333754) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2025-04-16 |