| NPI | 1609120237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71005772A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA 14165 NP) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2023-03-16 |