| NPI | 1689681249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI NPP37403) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 154665) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |