| NPI | 1417722612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: MA RN2308093) |
| Additional Taxonomies | 163WC0400X Registered Nurse Case Management (Licence: MA RN2308093) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2024-04-14 |