| NPI | 1295259224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A005175) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 23734) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2019-04-17 |