| NPI | 1427542927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP11408) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AZ AP11408) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP11408) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-12-18 |