NPI | 1033580188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2262349) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2262349) |
363L00000X Nurse Practitioner (Licence: MA RN2262349) | |
Enumeration Date | 2015-10-15 |
Last Update Date | 2022-09-26 |