| NPI | 1972110922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: NV 843279) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 246116) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: NV 843279) | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2023-01-19 |