| NPI | 1982448056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2024022023) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2024022023) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-07-12 |