| NPI | 1972574747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 165044) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: MA 165044) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |