| NPI | 1144650128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 34768) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 265972) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 34768) | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2024-09-04 |