| NPI | 1952948176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2296737) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NH 07121723) |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2020-04-10 |