NPI | 1477008563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2273365) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2273365) |
Enumeration Date | 2016-08-18 |
Last Update Date | 2022-08-11 |