| NPI | 1073034856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024175004) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024175004) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2023-01-26 |