| NPI | 1912446097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VT 101-0128302) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: VT 101.0128302) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2022-08-12 |