| NPI | 1821480047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 19325) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 19325) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2020-03-20 |