| NPI | 1366067373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: VA 0024179499) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: VA AG06200129) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: VA 0024179499) | |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2022-12-30 |