| NPI | 1861029159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: ID NP-75863) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: OR 202000267NP-PP) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-02-29 |