| NPI | 1023761939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2022017081) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2014022787) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 53-81058-071) | |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2024-03-26 |