| NPI | 1154994499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2309492) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2309492) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-09-02 |