| NPI | 1083076269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 810017) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN82632) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2018-07-09 |