| NPI | 1427419530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95003996) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 758826) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-03-16 |