| NPI | 1013539188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN10017792) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 9018) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2025-07-02 |