NPI | 1497239347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2323287) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2323287) |
Enumeration Date | 2018-09-17 |
Last Update Date | 2023-08-08 |