NPI | 1114484482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 817260) |
Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NV 817260) |
Enumeration Date | 2019-02-22 |
Last Update Date | 2021-11-19 |