| NPI | 1891078564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-100941) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-100941) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2024-09-26 |