| NPI | 1710653662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71011515A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IN 71011515A) | |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2022-01-07 |