| 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 |