| NPI | 1376224535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR 225619) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR 225619) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2023-08-17 |