| NPI | 1700269750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist Gerontology (Licence: AR A004437) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A004437) |
| 364SA2100X Clinical Nurse Specialist Acute Care (Licence: AR AA04437) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2017-01-04 |