| NPI | 1043509490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 812325) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 20534) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 20534) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 20534) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2018-10-19 |