| 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 |