| NPI | 1770239816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2331653) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2331653) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2023-08-24 |