| NPI | 1417655713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: ID 75389) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: ID 75389) |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-06-02 |