| NPI | 1730752890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2297082) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MA RN2297082) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2023-09-30 |