| NPI | 1245829118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NM 62532) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM 62532) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NM 62532) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NM 62532) | |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2021-04-15 |