| NPI | 1114714276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NE 115914) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H183881) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2025-04-22 |