| NPI | 1295198927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71006148A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71006148) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2021-02-03 |