| NPI | 1740847615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 220834) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 220834) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 220834) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ 220834) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2020-07-13 |