NPI | 1013778596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MS 906487) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 3555) |
Enumeration Date | 2024-01-22 |
Last Update Date | 2024-06-24 |