| NPI | 1194504175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5019050) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5019050) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5019050) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5019050) | |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2024-05-28 |