| NPI | 1073240149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2322883) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2322883) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2023-05-23 |