| NPI | 1275034845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: GA GAA-NP001537) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: MT NUR-APRN-LIC-191017) |
| 363L00000X Nurse Practitioner (Licence: IN 71015592A) | |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2024-08-28 |