| NPI | 1770034621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2292188) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2292188) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2292188) | |
| 163W00000X Registered Nurse (Licence: MA RN2292188) | |
| Enumeration Date | 2016-10-16 |
| Last Update Date | 2021-10-05 |