| NPI | 1457912065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X (Licence: NH 069735-23) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 069735-23) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NH 069735-23) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-08-26 |