| NPI | 1427618065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024177724) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024177724) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024177724) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: VA 0024177724) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-03-21 |