| NPI | 1558718957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2307934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 2307934) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2307934) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2022-03-01 |