| NPI | 1013319334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ND R41352) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: ND R41352) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2015-12-28 |