| NPI | 1336532456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 19347) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 19347) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 19347) | |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2015-03-13 |