| NPI | 1144363342 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024169483) | 
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC RN967155) | 
| Enumeration Date | 2007-02-15 | 
| Last Update Date | 2025-06-19 |