| NPI | 1104471416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2320575) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MA RN2320575) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2320575) | |
| Enumeration Date | 2019-08-04 |
| Last Update Date | 2021-11-11 |