| NPI | 1578158465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024182828) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001270289) |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2022-07-27 |