| NPI | 1184217085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA NP290011) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA 290011) |
| 207R00000X Internal Medicine (Licence: GA 290011) | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2026-08-04 |