| NPI | 1548032006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 299495) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: AZ 299495) |
| 363L00000X Nurse Practitioner (Licence: AZ 299495) | |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2025-07-03 |