| NPI | 1841706249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2320261) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2320261) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2019-10-03 |