| NPI | 1972957637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2299146) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MA RN2299146) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2024-09-17 |