| NPI | 1780324442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM 67636) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 8559879) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1074020) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1074020) | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2023-04-17 |