| NPI | 1609406164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN209517) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MA RN209517) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: MA RN209517) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: MA RN209517) | |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-10-24 |