| NPI | 1750987947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: HI APRN-3454) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024180644) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2022-04-19 |