| NPI | 1104436575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H160154) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NE 113254) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2020-08-24 |