| NPI | 1841713922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3012612) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95006832) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95006832) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2020-09-16 |