| NPI | 1043611023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A153963) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5007151) |
| 363L00000X Nurse Practitioner (Licence: IA A153963) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IA A153963) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5007151) | |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2023-03-07 |