| NPI | 1528522083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28167374A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28167374A) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-02-25 |