| NPI | 1730943390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 35852) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 127231) |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-04-03 |