| NPI | 1922523836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 7889-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 7889-33) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2017-09-25 |