| NPI | 1457600470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 16327) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA 16327) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 16327) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2022-01-03 |