| NPI | 1285414870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 103448) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 103448) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-06-10 |