| NPI | 1437551850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 6018) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 6018) |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: WI 6018) | |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2017-12-14 |