| NPI | 1881011765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA 2285227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2285227) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-09-05 |