| NPI | 1013965862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2018031144) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A01527) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 137590) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2018-12-27 |