| NPI | 1891302287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5013617) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 5013617) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5013617) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5013617) | |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |