NPI | 1568050136 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71010741A) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71010741A) |
363LF0000X Nurse Practitioner, Family (Licence: IN 71010741A) | |
Enumeration Date | 2021-01-08 |
Last Update Date | 2025-09-16 |