| NPI | 1124492798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: DC NP500003630) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP 9323295) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2022-07-20 |