| NPI | 1881382174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95024960) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95024960) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-09-01 |