| NPI | 1346612496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN206254) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: GA RN206254) |
| 364SG0600X Clinical Nurse Specialist Gerontology (Licence: GA RN206254) | |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2020-08-26 |