| NPI | 1679214977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NH 061314-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 061314-21) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2022-07-08 |