| NPI | 1538949862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5019001) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 284503) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5019001) | |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2023-12-21 |