| NPI | 1326927013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 17349-33) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: WI 17349-33) |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2025-12-08 |