| NPI | 1710812797 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 2026024452) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA 2026024452) |
| Enumeration Date | 2026-06-12 |
| Last Update Date | 2026-06-12 |