NPI | 1033587415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2291839) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2291839) |
Enumeration Date | 2015-09-02 |
Last Update Date | 2015-09-02 |