| NPI | 1215671128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2022024067) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2003020380) |
| 363L00000X Nurse Practitioner (Licence: MO 2022024067) | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-08-05 |