NPI | 1912439647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN217300) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704416472) |
Enumeration Date | 2017-03-31 |
Last Update Date | 2024-08-12 |