| NPI | 1508211921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NM CNP-02971) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN0000020977) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-09-20 |