| NPI | 1770051229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60879306) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60879306) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-12-06 |