| NPI | 1780100586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7892) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 7892-33) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2022-07-21 |