| NPI | 1891240610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 7194) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 7194) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2018-12-05 |