| NPI | 1639944788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2345560) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MA RN2345560) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2026-07-15 |