| NPI | 1154106268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2024042617) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5018740) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC BISS-4U91G) | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2026-02-04 |