| NPI | 1326422924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP08442) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08442) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2023-10-16 |