| NPI | 1972368595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: ID 75604) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 75604) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2025-06-10 |