| NPI | 1982470902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IN 71014688A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71014688A) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2024-01-15 |