| NPI | 1366852352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NV APRN022755) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP10086) |
| 207R00000X Internal Medicine (Licence: NV APRN002755) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2024-02-19 |