| NPI | 1821607243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2361180) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 9192) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2022-03-28 |