| NPI | 1063065373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024177892) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: VA 0001252679) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-07-23 |