| NPI | 1629843024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024188502) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0024188502) |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-16 |