| NPI | 1689154478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 902736) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 24489) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2020-09-01 |