| NPI | 1386316628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 30563) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000248465) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 30563) | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2022-03-26 |