| NPI | 1649644618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201902325NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000020683) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TN APN0000020683) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201902325NP-PP) | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2020-01-24 |