| NPI | 1699862334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR P00485) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR A01346) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |