| NPI | 1598362311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2293550) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI APRN02417) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-19 |