| NPI | 1982424958 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2310679) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: MA RN2310679) |
| Enumeration Date | 2024-10-15 |
| Last Update Date | 2024-10-15 |