| NPI | 1528526464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NM 55465) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NM 55465) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2022-09-24 |