| NPI | 1457899296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95005856) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: HI APRN-2218) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP95005856) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: HI APRN-2218) | |
| 163WG0600X Registered Nurse, Gerontology (Licence: CA RN95111445) | |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2023-03-07 |