| NPI | 1871359125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NM 84621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R27383) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: NM 84621) | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2025-06-27 |