| NPI | 1629388293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 2258946) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2258946) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2025-01-06 |