| NPI | 1043862774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MT NUR-APRN-LIC-206610) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AK 147811) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-08-22 |