| NPI | 1750747309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 26086) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20863) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2022-07-13 |