| NPI | 1366888919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209028547) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 23062) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP128006) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2024-04-26 |