| NPI | 1972212769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2324372) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MA RN2324372) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2023-06-17 |