| NPI | 1144009713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71015716A) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IN 28267039A) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-09-27 |