| NPI | 1588365548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 2022067388) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA 2022067388) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MA 2022067388) | |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2023-05-31 |