NPI | 1578935649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN00743) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: RI APRN00743) |
Enumeration Date | 2015-10-28 |
Last Update Date | 2015-10-28 |