| NPI | 1902283930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN APN0000019913) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 19913) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: TN 19913) | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2022-10-25 |