| NPI | 1124471230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: NV 822979) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95040483) |
| 363L00000X Nurse Practitioner (Licence: CA 95004834) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-03-07 |