NPI | 1518633486 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R228052) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD Pending) |
Enumeration Date | 2021-08-19 |
Last Update Date | 2024-03-07 |