| NPI | 1831704113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95015271) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95015271) |
| Enumeration Date | 2020-09-13 |
| Last Update Date | 2021-02-26 |