| NPI | 1740610385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5602) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 5602-33) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2021-02-22 |