| NPI | 1568867232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WI 6087-33) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical (Licence: WI 183006-30) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2021-04-29 |