| NPI | 1689179814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP11138) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP11138) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP11138) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2019-07-15 |