| NPI | 1609044734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN280332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 280332) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2015-01-08 |