NPI | 1639834575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71011767A) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 71011767A) |
Enumeration Date | 2021-11-04 |
Last Update Date | 2024-03-21 |