| NPI | 1790592913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: HI APRN-5385) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN-125296) |
| 163W00000X Registered Nurse (Licence: WA RN61347958) | |
| Enumeration Date | 2024-12-11 |
| Last Update Date | 2025-08-08 |