| NPI | 1770937294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71006307A) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71006307A) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2025-11-12 |