| NPI | 1851945687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1014388) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1014388) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704258160) | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2023-03-14 |