NPI | 1629388293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 2258946) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2258946) |
Enumeration Date | 2010-10-18 |
Last Update Date | 2025-01-06 |