| NPI | 1104579770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IN 71012225A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28157506A) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2023-10-11 |