| NPI | 1174890107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: HI 1399) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: HI 1399) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2024-05-17 |