| NPI | 1265290258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 35965) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 221638) |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2024-06-17 |