| NPI | 1922765197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2361554) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2361554) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2022-03-21 |