| NPI | 1679011654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60725065) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60725065) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2025-08-04 |