NPI | 1528676715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ 264551) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 264551) |
Enumeration Date | 2020-07-14 |
Last Update Date | 2025-04-30 |