| NPI | 1194281584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018033937) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.018613) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2017037322) | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2021-03-12 |