| NPI | 1518167139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024167444) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024167444) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024167444) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024167444) | |
| Enumeration Date | 2007-07-21 |
| Last Update Date | 2021-10-02 |