| NPI | 1518492487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2017017455) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2009016845) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-03-05 |