| NPI | 1003245457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA ap61299531) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SPO13376) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11005143) | |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2024-02-06 |