| NPI | 1841024908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 4027556) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1132185) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-09-10 |