| NPI | 1225600745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: GA RN311141) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2324549) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-05-04 |