| NPI | 1689288417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NV 835319) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3015021) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2022-11-13 |