| NPI | 1568050136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71010741A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010741A) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2022-07-14 |