| 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) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G161610) | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-06-18 |