| NPI | 1821820176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2325307) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2325307) |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2024-09-07 |