| NPI | 1902304546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F344274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2315402) |
| 163W00000X Registered Nurse (Licence: NY 765085) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2019-06-26 |