| NPI | 1336689421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60703347) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60703347) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2023-02-06 |