| NPI | 1790140937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: ID 2161178) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9415036) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2024-10-30 |