NPI | 1710456157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5019062) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9361615) |
363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9361615) | |
Enumeration Date | 2018-11-15 |
Last Update Date | 2024-02-02 |