| NPI | 1629649314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IN 71011422A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IN 71011422A) |
| 364SG0600X Clinical Nurse Specialist Gerontology (Licence: IN 71011422A) | |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2022-01-14 |