| NPI | 1558977322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10382-33) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 10382-33) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2026-05-08 |