| NPI | 1225619232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2017040113) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2017040113) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2017040113) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |