| NPI | 1790334241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R180781) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC RN1024901) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R180781) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DC RN1024901) | |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2019-09-07 |