| NPI | 1023412475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028087) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NY 431095) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2024-06-19 |