| NPI | 1649768920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA APRN-NP236766) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN236766) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN236766) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2026-03-11 |