| NPI | 1497284475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2017024422) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2014005849) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2017-07-14 |