NPI | 1861896839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2259843) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2259843) |
Enumeration Date | 2014-10-20 |
Last Update Date | 2022-04-28 |