| NPI | 1912583147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2293398) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MA RN2293398) |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2022-09-27 |