| NPI | 1659932580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R32408) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: ND R32408) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2022-11-17 |