| NPI | 1841985645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 083178-23) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 083178-23) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-08-05 |