NPI | 1922715903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2335434) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2335434) |
Enumeration Date | 2022-10-31 |
Last Update Date | 2023-11-22 |