| NPI | 1649583535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5008413) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 4185) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2023-10-12 |