| NPI | 1740822576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95034702) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP143487) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2025-06-12 |