| NPI | 1598141236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13486) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9262011) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 13486) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024184216) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024184216) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 13486) | |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2023-06-15 |