| NPI | 1609431220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 226334) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NE 112697) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2022-02-16 |