| NPI | 1699228866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95016956) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 689381) |
| 363L00000X Nurse Practitioner (Licence: NY F308129) | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2026-04-27 |