NPI | 1205461522 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61054509) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60575277) |
Enumeration Date | 2020-03-06 |
Last Update Date | 2020-11-12 |