| NPI | 1710589486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2316112) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2316112) |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2021-03-27 |