| NPI | 1063291847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95027332) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV TEMP897150) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1138148) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 333548) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10055339) | |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2026-01-20 |