| NPI | 1295131688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN613234) |
| 163W00000X Registered Nurse (Licence: DE L1-0069702) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LP-0010529) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DE LP-0010529) | |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2022-05-31 |