| NPI | 1417706623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010513) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0048020) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DE LP-0010513) | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-07-12 |