| NPI | 1164471926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3002206) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: TN 0242744-23) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2018-07-16 |