| NPI | 1497234884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60951857) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60951857) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP138293) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2020-12-02 |