| NPI | 1386123446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71008101A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28190622A) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2021-03-09 |