| NPI | 1902412661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LP-0010386) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0041369) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DE LP-0010386) | |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-10-07 |