| NPI | 1881275006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201910660NP-PP) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: OR 201910660NP-PP) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201910660NP-PP) | |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2021-09-15 |