NPI | 1962912964 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2263012) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2263012) |
Enumeration Date | 2017-10-04 |
Last Update Date | 2017-10-04 |