| NPI | 1437704491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IN 71009173A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IN 71009173A) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2021-01-22 |