| NPI | 1639816168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 12905695-4405) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: UT 10222556-3102) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-12-12 |