| NPI | 1235408048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201806622np-pp) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 340831) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2020-04-21 |