NPI | 1467002097 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024182996) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN02131) |
Enumeration Date | 2019-09-16 |
Last Update Date | 2024-11-08 |