| NPI | 1104253434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 063188-23) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 063188-23) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101.0118274) | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2022-08-17 |