| NPI | 1497221196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2018038262) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95015786) |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2023-11-16 |