| NPI | 1851718605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95000451) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95000451) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95000451) | |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2023-06-28 |