| NPI | 1639915911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7205712-4405) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: UT 7205712-4405) |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2024-08-23 |