| NPI | 1255806584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11000198) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9354510) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9354510) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 9354510) | |
| Enumeration Date | 2018-10-13 |
| Last Update Date | 2021-02-08 |