| NPI | 1831864255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5015021) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5015021) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5015021) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-07-15 |