NPI | 1790131894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MA 280256) |
Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: RI APRN01349) |
Enumeration Date | 2016-05-06 |
Last Update Date | 2018-03-17 |