| NPI | 1457024960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 12181) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 0029403) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2022-12-09 |