| NPI | 1235691189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 2018068953) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-144765) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-06-09 |