| NPI | 1164996369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 22548) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 22548) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 22548) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 22548) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2020-10-13 |