| 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 |