| NPI | 1790495257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA GAA-NP001561) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.417501) |
| Enumeration Date | 2022-11-24 |
| Last Update Date | 2023-11-11 |