| NPI | 1346580453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5006084) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5006084) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2018-08-28 |