| NPI | 1396555041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 38193) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 230704) |
| 363L00000X Nurse Practitioner (Licence: TN 38193) | |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-03-04 |