NPI | 1447867700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5013648) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024189607) |
363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024189607) | |
Enumeration Date | 2020-09-29 |
Last Update Date | 2024-03-07 |