| NPI | 1043845787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-153719) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AL 1-153719) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-153719) | |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |