| NPI | 1245017375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ID 61448) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: ID 61448) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: ID 61448) | |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2025-03-30 |