| NPI | 1912632852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 226875) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: LA 226875) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2023-02-08 |