| NPI | 1518526409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5011972) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 22235) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2020-02-21 |