| NPI | 1396153797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R189085) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R189085) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R189085) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2026-07-21 |