| NPI | 1740698893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 111800-23) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2287887) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2026-06-04 |