| NPI | 1508309105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2362882) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001254489) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024174267) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.022686) | |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: VA 0015001045) | |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2023-12-11 |