| NPI | 1154458412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71002351A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024171234) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-11-12 |