| NPI | 1548716749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2266793) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: VA 0024173802) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2019-07-21 |