| NPI | 1679358931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 75399) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NM 75399) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2023-11-16 |