| NPI | 1558973396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2308844) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2308844) |
| Enumeration Date | 2020-08-22 |
| Last Update Date | 2024-01-16 |