| NPI | 1982377891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014793) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5014793) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2023-05-12 |