| NPI | 1467173617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1174006) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2022023179) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2024-09-06 |