| NPI | 1922479799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN235848) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NH 072574-23) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2016-09-17 |