| NPI | 1053561290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 18429) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: CA 3055) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2008-09-24 |