| NPI | 1740917640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR 219081) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 32371) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-07-25 |