| NPI | 1497464622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61411287) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11023051) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61411287) | |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2023-11-03 |