NPI | 1992296545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95011154) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP018742) |
Enumeration Date | 2018-05-18 |
Last Update Date | 2023-06-20 |