| NPI | 1679113054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R149435) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R149435) |
| 363LS0200X Nurse Practitioner, School (Licence: MD R149435) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R149435) | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2023-11-08 |