| NPI | 1386004091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: RI APRN00836) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN47897) |
| 163WG0600X Registered Nurse, Gerontology (Licence: RI RN47897) | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-03-30 |