| NPI | 1992021315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2330343) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 14835) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2020-03-06 |