| NPI | 1285032979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5007705) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NH 059325-23) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN245834) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5007705) | |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2019-11-09 |