| NPI | 1346049376 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: CA 5067) | 
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: CA 5067) | 
| Enumeration Date | 2025-03-11 | 
| Last Update Date | 2025-03-11 |