NPI | 1235861766 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2021044288) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2021044288) |
Enumeration Date | 2022-06-24 |
Last Update Date | 2022-06-24 |