| NPI | 1871147264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MA 266267) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT 132742) |
| 163W00000X Registered Nurse (Licence: WA 60919611) | |
| 163WG0100X Registered Nurse, Gastroenterology (Licence: MA 266267) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2022-10-20 |