| NPI | 1417589656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 8735) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 8735) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2021-03-08 |