| NPI | 1194216895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: UT 7321629-8900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 7321629-4405) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2026-02-10 |