| NPI | 1902667611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5019464) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC PETT-PPESJ) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-05-07 |