NPI | 1124791678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71011370A) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71011370A) |
Enumeration Date | 2021-07-30 |
Last Update Date | 2024-07-10 |