| 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 |