| NPI | 1184292203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10722) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 10722) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-02-05 |