| NPI | 1962074898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3018712) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: IL 209023573) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2024-01-08 |