NPI | 1639667561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2299369) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2299369) |
Enumeration Date | 2018-04-26 |
Last Update Date | 2023-06-21 |