| NPI | 1912432691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5016740) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: AZ RN164810) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP10421) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2022-09-26 |