| NPI | 1609369164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: FL 1852182) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 1852182) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 1852182) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 1852182) | |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2018-06-10 |