| NPI | 1679210538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 849173) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NV 849173) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-09-15 |