| NPI | 1184496937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 291183) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 291183) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ 291183) | |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2025-08-26 |