| NPI | 1417911991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 075181) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: MO 075181) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2007-07-08 |