| NPI | 1184921157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 202113485NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP56556) |
| Enumeration Date | 2011-02-27 |
| Last Update Date | 2023-04-26 |