| NPI | 1376066159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 21129) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 21129) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-12-20 |