| NPI | 1851113054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 14063) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 14063) |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2025-03-26 |