| NPI | 1275241978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2022042410) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: KS 53-81732-062) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2023-07-25 |