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 |