| NPI | 1679925291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2299435) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: RI APRN01409) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2023-04-17 |