| NPI | 1154889707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AR A006076) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: AR A006076) |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2019-08-15 |