| NPI | 1770116477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 24114) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 24114) |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2023-01-10 |