| NPI | 1699194472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 9405) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 18263) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 18263) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: SC 18695) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2026-04-18 |