| NPI | 1033821236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017378) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC Semi-E0FNU) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2023-02-07 |