| NPI | 1154000776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MA RN2358395) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: MA RN2358395) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2023-07-26 |