| NPI | 1164131637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017278) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NC BARR-DUZ85) |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-08-19 |