| NPI | 1508591132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: TX 1002145) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1002145) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-11-28 |