| NPI | 1437790029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 26652) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN122151) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2023-07-03 |