| NPI | 1316316698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2015016104) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2015016104) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2015016104) | |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2016-03-09 |