| NPI | 1588149520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R198104) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC RN1018367) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2020-10-30 |