| NPI | 1972195527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 26043) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5014070) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5014070) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 26043) | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2022-09-28 |