| NPI | 1114379435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3010647) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28199081A) |
| 163W00000X Registered Nurse (Licence: KY 1087636) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-11-27 |