| NPI | 1972340073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA Rn282456) |
| Additional Taxonomies | 163WN0300X Registered Nurse, Nephrology (Licence: MA RN282456) |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2025-07-24 |