| NPI | 1669800843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5008614) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 18552) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2023-05-15 |