| NPI | 1861768178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2266074) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN 2266074) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2025-07-30 |