| NPI | 1821879784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2356463) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: MA RN2356463) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2023-11-14 |