| 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 |