NPI | 1285904805 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM 58571) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 6565) |
363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN189928) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN189928) | |
Enumeration Date | 2012-01-12 |
Last Update Date | 2023-01-27 |