| NPI | 1629536214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 903210) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MS 903210) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |