| NPI | 1699104448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: MA RN2275851) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: RI NPP37808) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2275851) | |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2018-03-17 |