| NPI | 1790724912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 215647NP) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MA 215647) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 215647NP) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-08-13 |