| NPI | 1518449198 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2266550) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 145419) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2266550) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-11-27 |