| NPI | 1376028167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 22226) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 22226) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 22226) | |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2025-11-18 |