| NPI | 1760827372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1621A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP6085682) |
| 363LF0000X Nurse Practitioner, Family (Licence: GU 22NP01) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT 1251200) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GU 22R030) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2022-03-05 |