| NPI | 1063992857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H161051) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 6124) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 6124) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 2464790) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2020-10-20 |