| NPI | 1437464799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: GA 231437) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 285083) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: MA 285083) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: MA 285083) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: GA 231437) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2015-10-14 |