| NPI | 1275893968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201702166NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-01988) |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: NM CNP-01988) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2022-12-06 |