| NPI | 1275948309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 18858) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 18858) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2021-06-11 |