| NPI | 1043852478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R185125) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R185125) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R185125) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-12-01 |