| NPI | 1235594441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71007316A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP015419) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2024-02-24 |