| NPI | 1306292719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2274662) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2274662) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2274662) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2018-06-20 |