| NPI | 1821614264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2023037909) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 79470) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-11-02 |