| NPI | 1174122121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR 212494) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR 212494) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2022-02-23 |