| NPI | 1710376165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2020018088) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR ATP-000747) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2020-07-21 |