| NPI | 1366060691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 311191) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28213561A) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71010218A) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2023-06-28 |