| NPI | 1871946152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2307077) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000213934) |
| 163W00000X Registered Nurse (Licence: MA 2307077) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 23169) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 23169) | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2022-06-02 |