| NPI | 1326405408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: NV APRN002146) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NV APRN00214600) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: MD R199626) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2022-10-21 |