| NPI | 1063985521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024176978) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5011226) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH CNP.026029) | |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2023-10-24 |