NPI | 1578150173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11010831) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11010831) |
Enumeration Date | 2020-12-29 |
Last Update Date | 2021-04-20 |