NPI | 1730752890 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2297082) |
Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MA RN2297082) |
Enumeration Date | 2021-07-19 |
Last Update Date | 2023-09-30 |