| NPI | 1780229229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 26810) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 26810) |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-18 |