NPI | 1144799073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 810244) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 810244) |
Enumeration Date | 2018-11-20 |
Last Update Date | 2018-11-20 |