| NPI | 1639282783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 13192) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F334091) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2026-03-19 |