| NPI | 1568025146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN259758) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 8168) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 8618) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-08-11 |