| NPI | 1770289134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5018803) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NC 5018803) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: NC 295760) | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-10-10 |