| NPI | 1366002610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2019034747) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO AG06190034) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-11-27 |