| NPI | 1538781893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014073) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5014073) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 163WA2000X Registered Nurse, Administrator (Licence: NC 212138) | |
| Enumeration Date | 2020-05-10 |
| Last Update Date | 2021-06-22 |