| NPI | 1013471309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 221810) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: AZ 221810) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: AZ 221810) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-01-30 |