| NPI | 1710578711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014541) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC Doel-H3NKF) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-10-06 |