| NPI | 1215358288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024171263) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024171263) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2024-01-16 |