| NPI | 1417353608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2014038385) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2009003804) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2014038385) | |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2014-11-14 |