| NPI | 1932655198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2277349) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: MA AG0616286) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-12-30 |