| NPI | 1184064941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MD R179907) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: MD R179907) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: MD R179907) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-05-14 |