| NPI | 1861009664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV 834774) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NV 834774) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 834774) | |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NV 824774) | |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2020-11-19 |