| NPI | 1376961011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 334347-4405) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AK 1432) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AK 1432) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2024-03-07 |