| NPI | 1487329884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 28572) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 28572) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2023-01-23 |