NPI | 1144610684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP7623) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP7623) |
Enumeration Date | 2015-02-04 |
Last Update Date | 2016-04-19 |