| NPI | 1235959529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA AG09240067) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2381302) |
| Enumeration Date | 2024-10-12 |
| Last Update Date | 2025-05-02 |