| NPI | 1982479283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 40001) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000214686) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2025-11-17 |