| NPI | 1043091408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 12.012499) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 12.012499) |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2024-03-11 |