| NPI | 1346653953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201404024NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 0000185764) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2021-12-20 |