| NPI | 1114484482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 817260) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 817260) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2021-11-19 |