| NPI | 1568866796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: RI APRN00868) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN265307) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2018-08-02 |