| NPI | 1346713948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 903628) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000025081) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2020-06-22 |