| NPI | 1235782475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 150766) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 150766-30) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-09-25 |