| NPI | 1992209399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN253536) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 253536) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2019-11-11 |