| NPI | 1558876326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014418) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5014418) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5014418) | |
| Enumeration Date | 2017-12-02 |
| Last Update Date | 2024-07-25 |