| NPI | 1578969010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MD R224283) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2014039712) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: MO 2014039712) | |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2023-06-26 |