| NPI | 1093190795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5007800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5007800) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2024-04-03 |