| NPI | 1578027033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 25481) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2009024072) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2024-10-22 |