| NPI | 1336893692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 270825) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1144183) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2023-02-01 |