| NPI | 1881130144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 058712-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN276386) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2017-02-10 |