| NPI | 1659823136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2276898) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MA RN2276898) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2020-11-16 |