| NPI | 1154038297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11022758) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9386555) |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2022-10-28 |