| NPI | 1740395185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MA RN178632) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MA 178632) |
| 363L00000X Nurse Practitioner (Licence: MA 178632) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-03-16 |