| NPI | 1164902185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: HI 2500) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: HI 2500) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: HI 2500) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2022-09-20 |