| NPI | 1407467038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA NP000242) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: SC 24230) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: GA GAA-NP000242) | |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2026-07-22 |