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 |