| NPI | 1407467038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 24230) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 24230) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2023-06-22 |