| NPI | 1972922193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-127539) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-127539) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-10-01 |