| NPI | 1508245853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: DE LP-0000136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0041169) |
| 163W00000X Registered Nurse (Licence: PA RN606427) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0000136) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP014467) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP014467) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DE LP-0000136) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP014467) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2017-05-31 |