| NPI | 1366986374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009131) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201809919NPPP) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2021-06-14 |