| NPI | 1376275420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 26633) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H169714) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2023-11-21 |