| NPI | 1821885468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN300397) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN300327) |
| Enumeration Date | 2025-04-24 |
| Last Update Date | 2025-07-23 |