| NPI | 1316323777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011543) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61151041) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5011543) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN210225) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5011543) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN210225) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2023-04-25 |