| NPI | 1467011239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR 215134) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX Ap141588) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2026-06-16 |