| NPI | 1164272100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 28859) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: SC 219551) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-06-12 |