NPI | 1093141129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IA H116388) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IA h116388) |
Enumeration Date | 2013-09-20 |
Last Update Date | 2018-03-08 |