| NPI | 1720449150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 307603) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN282295) |
| Enumeration Date | 2016-03-12 |
| Last Update Date | 2021-12-07 |