| NPI | 1881275477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 085918-23) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 085918-23) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2315152) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2315152) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2021-10-11 |