| NPI | 1538235551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: FL 9227984) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9227984) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL 9227984) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: FL 9227984) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-07-27 |