| NPI | 1770110298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5011671) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 9046-33) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2020-03-25 |