| NPI | 1508426792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 12.008242) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 12.008242) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-07-31 |