| NPI | 1982329751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209025003) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 202209977NP-PP) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61290133) | |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-05 |