NPI | 1508211921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 258294) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 258294) |
Enumeration Date | 2016-05-04 |
Last Update Date | 2025-05-16 |