Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174V00000X | Clinical Ethicist |
NPI | 1659789766 |
---|---|
Provider Name | Matthew Mansfield |
First Address | Broseley, MO 63932-9174 |
Second Address | Broseley, MO 63932-9174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2014 |
Last Update Date | 01/08/2014 |