| NPI | 1164897112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV 847945) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP60616117) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: WA AP60616117) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: WA AP60616117) | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2024-01-29 |