| NPI | 1649277237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MT NUR-APRN-100295) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT NUR-RN-LIC-23565) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MT RN23565) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2023-03-07 |