| NPI | 1568345486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10048240) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 10048240) |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2025-11-25 |