| NPI | 1174900690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2283072) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2283072) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2015-05-05 |