| NPI | 1548711385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009002) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5009002) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 255846) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2023-08-07 |