| NPI | 1851637003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5005990) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5005990) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5005990) | |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2014-08-18 |