| NPI | 1609841014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN175412) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI NPP37098) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2011-05-19 |