| NPI | 1821854068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5020173) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN209339) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-06-07 |