| NPI | 1932670122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R184344) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD R184344) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R184344) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2022-02-17 |