| NPI | 1639667561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MA RN2299369) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MA RN2299369) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-06-21 |