| NPI | 1023660974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1066667) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11021135) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11021135) | |
| 163W00000X Registered Nurse (Licence: TN 232793) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 250379) | |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2023-02-15 |