| NPI | 1386340511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5018232) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5018232) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2024-12-09 |