| NPI | 1932604915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 24066) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 215329) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2020-12-10 |