| NPI | 1184931925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP19411) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: CA CNS3298) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2010-08-31 |