| NPI | 1073534855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 29752) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH NP08654) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2025-05-08 |