| NPI | 1588182950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP017604) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61333496) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2024-04-16 |