| NPI | 1205374386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-126235) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AL 1-126235) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-126235) | |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2023-06-29 |