| NPI | 1780682245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN216266) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 216266) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 236818) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2014-04-29 |