| NPI | 1467002097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: VA 0024182996) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: RI APRN02131) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2025-07-16 |