| NPI | 1376911156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: HI APRN - 1032) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN - 46763) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |