| NPI | 1356929699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 38743) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-159846) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-05-20 |