| NPI | 1629111232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 002031) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 2031) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2023-02-28 |