| NPI | 1891245734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024187160) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TX AP131585) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71013383A) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71013383A) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX ap131585) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2023-06-22 |