| NPI | 1245117175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KS 53-84781-052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13153722052) |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2025-09-26 |