NPI | 1649694779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 67812) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201504211NP-PP) |
363LG0600X Nurse Practitioner, Gerontology (Licence: NV APRN001600) | |
363L00000X Nurse Practitioner (Licence: FL APRN9474728) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9474728) | |
Enumeration Date | 2014-02-10 |
Last Update Date | 2024-01-04 |