| NPI | 1063998839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 007669) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 12.007669) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 007669) | |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2018-10-11 |