| NPI | 1427495167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61337929) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9293640) |
| 363L00000X Nurse Practitioner (Licence: FL APRN9293640) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9293640) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95002588) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2024-02-07 |