| NPI | 1669203774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 2024030897) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 2024030897) |
| Enumeration Date | 2024-08-10 |
| Last Update Date | 2024-08-10 |