| NPI | 1881022200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN283895) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307535) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2024-12-16 |