| NPI | 1508600354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-240075) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MT NUR-APRN-LIC-240075) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2024-07-09 |