| NPI | 1326409673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024195478) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11009585) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN179654) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN179654) | |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2025-11-28 |