| NPI | 1598374357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 9822771-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 9822771-8900) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2021-12-20 |