NPI | 1811429988 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN215482) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN215482) |
Enumeration Date | 2017-03-29 |
Last Update Date | 2020-08-20 |