| NPI | 1285359711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AK 200760) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AK 200760) |
| 163W00000X Registered Nurse (Licence: AK 197073) | |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2023-02-07 |