| NPI | 1558811190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5009004) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: NC 255629) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2021-03-30 |