NPI | 1811392871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95001244) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95001244) |
Enumeration Date | 2014-11-01 |
Last Update Date | 2025-06-25 |