| NPI | 1538716147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN265241) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MA RN265241) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2019-10-02 |