| NPI | 1881454601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AR 227525) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR 227525) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2026-04-02 |