| NPI | 1134781875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD AG07190058) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MN R206363) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD AG07190058) | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2026-03-13 |