| NPI | 1013654995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95017584) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 95017584) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-08-05 |