| NPI | 1154979946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-4512) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN-88156) |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: HI APRN-4512) | |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2026-06-03 |