| NPI | 1972098762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2345300) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 7627) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2021-02-11 |