| NPI | 1114393410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-113559) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R236186) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: TN 20325) | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2024-10-01 |