| NPI | 1356116057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 12566) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 12566) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2026-04-23 |