| NPI | 1124959002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0011071) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LP-0011071) |
| 163W00000X Registered Nurse (Licence: DE L1-0056186) | |
| Enumeration Date | 2026-05-28 |
| Last Update Date | 2026-06-18 |