| NPI | 1710680103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: ID 75819) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ID 75819) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2023-04-18 |