| NPI | 1164829057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 19170) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN19170) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TN APN19170) | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2021-10-20 |