| NPI | 1750407078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: NC 5008959) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5008959) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: NC 5008959) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NC 5008959) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2016-12-07 |