| NPI | 1518342963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R874532) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS R874532) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MS R874532) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 100221) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MS R874532) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 100221) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 100221) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2023-01-09 |