| NPI | 1295453397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2022020263) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2022020263) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2022020263) | |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2022-08-16 |