| NPI | 1750921896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IN 71009890A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IN 71009890A) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2022-07-22 |