NPI | 1982277505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR 213429) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 201953) |
363LG0600X Nurse Practitioner, Gerontology (Licence: OK 201953) | |
Enumeration Date | 2021-07-21 |
Last Update Date | 2022-10-12 |