| NPI | 1609326289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP8990) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: AZ ap8990) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2025-01-28 |