| NPI | 1083368047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 67740) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 5380849052) |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2022-07-27 |