| NPI | 1114492048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: DC RN1042832) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1049487) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: WI 13684) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1049487) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: WI 13684) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: TX 1049487) | |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2024-06-27 |