| NPI | 1194234047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP09406) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: LA AP09406) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA APO9406) | |
| 363L00000X Nurse Practitioner (Licence: LA AP09406) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2026-01-30 |