| NPI | 1194175505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NC 5008605) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NC 5008605) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2023-12-22 |