| NPI | 1578934899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-132399) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: AL 1-132399) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2016-10-19 |