| NPI | 1649785262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VT 101.0134723) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: RI aprn01735) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2026-07-09 |