| NPI | 1477005205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NH 067070-23) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NH 067070-23) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2023-10-11 |