| NPI | 1215655790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: LA 227594) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: LA RN126945) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2022-10-26 |