| NPI | 1821572876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10003142) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 20652) |
| 363L00000X Nurse Practitioner (Licence: OR 10003142) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20652) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 10003142) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 10003142) | |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TN 20652) | |
| Enumeration Date | 2018-09-15 |
| Last Update Date | 2023-06-08 |