| NPI | 1669860540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: SC 19225) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: SC 19225) |
| 363L00000X Nurse Practitioner (Licence: SC 19225) | |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2020-12-14 |