| NPI | 1548867948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024180223) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NV 838829) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NV 838829) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: NV 838829) | |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2021-06-10 |