| NPI | 1871950980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP8394) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP8394) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP8394) | |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2024-12-11 |