| NPI | 1366927857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2268627) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2268627) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2268627) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2268627) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2268627) | |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2024-08-23 |