| NPI | 1124754163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R225330) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11020932) |
| Enumeration Date | 2022-07-30 |
| Last Update Date | 2025-06-09 |