| NPI | 1356805717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 9510957) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 9510957) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-01-29 |