| NPI | 1548765167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5013570) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: NV APRN002862) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NV APRN002862) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-06-23 |