| NPI | 1255951547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD AC002818) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD AC002818) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD AC002818) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD AC002818) | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-04-10 |