| NPI | 1891420931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA 202864) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA 202864) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: LA 202864) | |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2022-09-15 |