| NPI | 1376062794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 10017536) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2272748) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1027411) | |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2024-04-05 |