| NPI | 1205378551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-121254) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-121254) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2023-06-29 |