| NPI | 1013365279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3010153) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WV APRN93802) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH 026360) | |
| Enumeration Date | 2016-05-28 |
| Last Update Date | 2022-01-05 |