| NPI | 1902380363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 008336) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 008336) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2023-03-09 |