| NPI | 1124371299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 065332-23) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP012463) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101.0090936) | |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2023-06-27 |