| NPI | 1669094397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 212776) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 903925) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2022-08-25 |