| NPI | 1265147482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 37372) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 205338) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2024-11-26 |