| NPI | 1295395564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD AC003398) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 226321) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2022-02-24 |