| NPI | 1750759007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 62353) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA N360592103) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2024-08-05 |