| NPI | 1174254700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NH 088555-23) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NH 088555-23) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2023-01-05 |