| NPI | 1770115925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 26953) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 26953) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2022-04-15 |