| NPI | 1649732637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 29145) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 29145) |
| 163W00000X Registered Nurse (Licence: AL 1-167002) | |
| 163W00000X Registered Nurse (Licence: TN 250649) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-08-30 |