| NPI | 1619340650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2015042043) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2015042043) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2024-09-20 |