| NPI | 1881321891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024187876) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024187876) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024187876) | |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2024-05-06 |