| NPI | 1366187858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 225741) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: LA 225741) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2025-01-09 |