| NPI | 1205832995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC G90136) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC R90136) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2012-11-26 |