| NPI | 1093164311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA H127990) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H127990) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2022-03-10 |