| NPI | 1891461265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5014901) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3019045) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5014901) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-05-08 |