| NPI | 1952595571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN192151) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 006366) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 006366) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2018-07-23 |