| NPI | 1548818750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1019745) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R196090) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DC NP1019745) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R196090) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DC NP1019745) | |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2023-09-03 |