| NPI | 1831604479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-125274) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-125274) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: AL 1-125274) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: AL 1-125274) | |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2018-01-17 |