| NPI | 1245857143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024179475) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NC 5045769) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2022-03-22 |