| NPI | 1811358211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 7661986-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 7661986-4405) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2024-05-07 |