| NPI | 1629404264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024171194) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: VA 0024171194) |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2022-02-02 |