| NPI | 1760900286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009849) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 5009849) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5009849) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5009849) | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-07-15 |