| NPI | 1538924691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5021056) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5021056) |
| 163W00000X Registered Nurse (Licence: NC 305433) | |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-10-25 |