| NPI | 1134852650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95021524) |
| Additional Taxonomies | 207RA0001X Internal Medicine, Advanced Heart Failure and Transplant Cardiology (Licence: CA 95021524) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2024-11-20 |