NPI | 1326796277 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN03026) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN-TEMP14701) |
363L00000X Nurse Practitioner (Licence: MA RN2338572) | |
Enumeration Date | 2022-03-10 |
Last Update Date | 2024-06-03 |