| NPI | 1588211627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: RI APRN03810) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 12105) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00945400) | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2024-08-28 |