| NPI | 1902320435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024174454) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024174454) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024174454) | |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2017-07-26 |