| NPI | 1760699540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS R826981) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: MS R826981) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2008-08-12 |