| NPI | 1518512029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 22946) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 22946) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD 2019027359) | |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2024-12-06 |