| NPI | 1497125025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71005736A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71005736A) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71005736A) | |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2022-05-19 |