| NPI | 1952466740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA F0898362) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: MA 202114) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2019-05-02 |