NPI | 1659815520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R181805) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R181805) |
Enumeration Date | 2016-12-13 |
Last Update Date | 2024-09-19 |