| NPI | 1154929131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-160696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 1-160696) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2023-06-30 |