| NPI | 1467961029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013068) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MD R210020) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R210020) | |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2020-07-27 |