| NPI | 1669712188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2261441) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: MA RN2261441) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2022-03-25 |